Medical billing/collections

Yvette Arton

*** *. ****** **. # *

La Habra, California 90631

********@***.***

Home: 562-***-****

Cell: 562-***-****

Primary

number

SUMMARY OF QUALIFICATIONS

. Over 24 years in the medical field.

. Effectively manages time; ability to prioritize tasks accordingly.

. Skilled in HMO, PPO, Medi-cal, CCS and Medicare billing procedures;

paper and electronic.

. Knowledgeable and experienced with ICD.9/CPT/HCPC coding.

. Knowledge of basic Anatomy and Physiology; Medical Terminology.

. Good eye for detail; well organized, skilled in setting priorities.

. Strong human relations, verbal and written communication skills.

PROFESSIONAL ACCOMPLISHMENTS

March 2014-Current

A/R Collector, Conifer

Anaheim, Ca.

. Conducts appropriate account activity on final billed claims by

contacting government agencies, third party payors, and

patients/guarantors via phone, e-mail, or online. Continues

collection activity until account is resolved, sent to Legal, or

disputed. Responsible for maintaining inventory on desks with no

backlog. Ensure daily productivity standards of assigned accounts are

met.

. Requests additional information from Patients, Medical Records, and

others upon request from payors. Reviews contracts and identify

billing or coding issues and request re-bills, secondary billing, or

corrected bills as needed.

. Updates Plan IDs and Patient/Payor demographic information; posts

notes and memos to accounts; identify payor issues and trends; and

solve recoup issues. Returns accounts to Appeal Writers for next

level appeals as needed.

. Identifies payor trends in payment delays and escalates issues to

Supervisor.

. Recognizes potential delays with payors such as corrective actions and

responds avoid A/R aging. Escalates payment delays/ problem aged

account timely to Supervisor.

. Perform special projects and other duties as needed. Assists with

special projects by utilizing excel spreadsheets, and must be able to

communicate results.

. Ensures compliance with State and Federal Laws Regulations for Managed

Care and other Third Party Payors.

. Conducts collection activity on previously appealed claims by

contacting government agencies, third party payers via phone, email,

or online. Provides ongoing appropriate collection activity on

appeals until the payer has responded to the appeal.

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October 2005-October 2008

Billing/Collections Supervisor, Elite Orthopedics and Sports Medicine

Irvine, Ca.

. Established all set up of billing procedures including computer program

updates; created fee tickets and all required forms for physical therapy

billing.

. Coded and entered all charges for our orthopedic surgeon and physical

therapy department.

. Verified insurance benefits/eligibility and determined required co-

payments and deductibles.

. Prepared electronic and paper claims for all insurance types, including

Medicare and Workers

Compensation.

. Tracked all Medicare physical therapy visits to make sure the cap amount

was not exceeded and determined which patient's were eligible for the cap

exception based on their diagnosis.

. Requested and obtained workers compensation and private insurance company

authorizations

for physical therapy. Monitored closely the number of authorized visits

being used during the

billing process in order to make sure requests were always made and

received in a timely

manner to ensure our patients continuity of care.

. Kept aging current and up to date for both patients and insurance

companies.

. Posted all A/R and was responsible for collections.

. Submitted amended authorization requests as needed to requesting

medical groups and IPAS.

. Entered all patient demographics and insurance information;

created/voided invoices.

. Evaluated and produced monthly sales/billing report; provided feedback to

management regarding company quotas being met.

July, 2000-October, 2005

Billing Coordinator, Human Designs Prosthetics and Orthotics Long

Beach, Ca.

. Prepared electronic and paper billing claims for

patients, hospitals and insurance companies.

. Verified insurance benefits/eligibility and determined required

patient co-payments.

. Reviewed authorizations for accuracy including ICD.9 and HCPC codes.

. Submitted amended authorization requests as needed to requesting

medical groups and IPAS.

. Entered all patient demographics and insurance information;

created/voided invoices.

. Evaluated and produced monthly sales/billing report; provided feedback to

management regarding company quotas being met.

. Requested Medi-Cal Tars, CCS/HMO authorizations, Workers Compensation

approvals, Rx's, letters of medical necessity and medical chart notes as

needed to complete the billing process and to avoid the possibility of

payment delay.

. Assisted in collections and A/R payment posting.

Page 2/Yvette Arton

April 2013-March 2014

Office/Billing Manager, Orange County Orthopedic Specialists Fountain

Valley, Ca.

. Restructured, organized and implemented policies and procedures, such

as sending patient's to collections as necessary after taking all the

appropriate steps to get a collection agency assigned. Created the

insurance verification form/policy so that all Medicare and PPO

patient benefits are made clear to the staff and the patient's prior

to their scheduled appointments, making it a lot easier for the

business office staff to answer billing/statement questions that the

patients may have as well as determining if payments are being made

correctly; EOB payment vs. the benefits that we are being quoted.

. I call all patient's with high deductibles prior to their scheduled

appointments and quote them an approximate amount that they will have

to pay at each visit as well as review all authorizations and request

modifications as necessary prior to their scheduled appointments.

. Complete all necessary Medicare/Medi-cal and other various insurance

enrollment forms, electronic billing, EFT and Pin number requests.

. Defined all duties for both billers, taught them how to do appeal

letters to include thorough documentation and follow ups until each

account's billing issues are resolved.

. Review A/R report monthly and work on any of the accounts that are

having collection issues; both with insurance companies and patients.

Clean up accounts that are set up wrong, rebill as necessary and

collect on any overdue/aged payments. Review EOB's to determine if

payments are correct or if any action is required in order to collect

the payments.

October 2008-April 2013

Billing/Collections/U.M Coordinator, Fullerton Physical Therapy

Fullerton, Ca.

. Posted all charges and payments for worker compensation patients.

. Checked all charts/fee tickets turned in by the practitioners, for

accuracy prior to billing.

. Attached copies of authorizations and necessary documentation prior to

mailing out claims.

. Obtained prescriptions/PR2; request and follow up on all

authorizations, prior to treatment.

. Contacted and schedule new patient's, once authorization is approved

and received.

. Worked all aspects of collections, within the worker compensation

arena.

. Made sure A/R was current and payments aren't unnecessarily delayed.

Page 4/Yvette Arton

ADDITIONAL EMPLOYMENT HISTORY

05/99-07/00 Utilization Management Associate

Managed Care Innovations

10/97-10/98 Data Entry Clerk

PSI-MED/Advanced Medical Billing

01/97-10/97 Referral Authorization Coordinator Arta Healthcare

5/96-11/96 Referral Authorization Coordinator University California

Los Angeles

EDUCATION

. Larson's Training Center, Inc., Carson California; Certificate of

Completion, Computer Based Business Skills and Medical Claims Processing

(01/27/99-04/22/99).

. Fullerton College, Fullerton, California, 9 semester hours completed in

General Studies.

PROFESSIONAL DEVELOPMENT

- Typing 70 + words per minute -Tiny Term

- 10-key by touch -PTOS

- Med-flex -NuMed

- On Staff/Prime clinical/EMR

- E-Z Cap/BMS

- Medisoft

- MS XP Professional; MS Excel 97/2003 References Furnished Upon

Request

Contact this candidate